Academic Medical Centre, 1100 DD Amsterdam, The Netherlands.
Eur J Endocrinol. 2014 Feb 7;170(3):461-8. doi: 10.1530/EJE-13-0769. Print 2014 Mar.
To determine whether thyroid hormone (free thyroxine (fT₄)) rather than TSH is directly related to bone mineral density (BMD).
Cross-sectional population cohort study of peri-menopausal women.
Of a sample of 6846 peri-menopausal Dutch women who participated in an osteoporosis-screening programme, a cohort of 2584 was randomly selected for the assessment of thyroid function (TSH, fT₄ and thyroid peroxidase antibodies (TPO-Abs)). TPO-Ab-positive women, with a previous history of thyroid dysfunction, overt thyroid disease, subclinical hypothyroidism, osteoporosis or bilateral oophorectomy and those receiving thyroid hormone or hormone replacement therapy were excluded. Of 1477 eligible women, 1426 had TSH and fT₄ within the reference range and 51 had low or undetectable serum TSH. BMD was measured at the lumbar spine and low BMD was defined as <0.937 g/cm(2).
The mean BMD in the 51 women with low or undetectable serum TSH was 0.984 g/cm(2) compared with 1.001 g/cm(2) in the remaining 1426 (t=0.94, P=0.35); 33% of women with low or undetectable serum TSH had low BMD compared with 34% in 1426 euthyroid women. High fT₄ but not low TSH in euthyroid women was related to low BMD by multiple logistic regression corrected for age, BMI and smoking (OR, 1.30; 95% CI, 1.02-1.69).
Higher fT₄ levels within the normal reference range but not low or undetectable serum TSH were independently related to decreased BMD at lumbar spine in peri-menopausal women.
确定甲状腺激素（游离甲状腺素（fT₄））而非 TSH 是否与骨密度（BMD）直接相关。
绝经前妇女的横断面人群队列研究。
在参加骨质疏松症筛查计划的 6846 名绝经前荷兰女性中，随机选择了 2584 名女性进行甲状腺功能（TSH、fT₄ 和甲状腺过氧化物酶抗体（TPO-Abs））评估。排除 TPO-Ab 阳性、有甲状腺功能障碍、显性甲状腺疾病、亚临床甲状腺功能减退、骨质疏松症或双侧卵巢切除术病史以及正在接受甲状腺激素或激素替代治疗的女性。在 1477 名符合条件的女性中，有 1426 名女性的 TSH 和 fT₄ 在参考范围内，51 名女性的血清 TSH 水平低或无法检测到。在腰椎处测量 BMD，将低 BMD 定义为 <0.937 g/cm(2)。
在 51 名血清 TSH 水平低或无法检测到的女性中，平均 BMD 为 0.984 g/cm(2)，而在其余 1426 名女性中为 1.001 g/cm(2)（t=0.94，P=0.35）；33%的血清 TSH 水平低或无法检测到的女性存在低 BMD，而在 1426 名甲状腺功能正常的女性中，这一比例为 34%。在校正年龄、BMI 和吸烟因素后，甲状腺功能正常的女性中高 fT₄但低 TSH 与低 BMD 相关（OR，1.30；95%CI，1.02-1.69）。
在绝经前女性中，正常参考范围内较高的 fT₄ 水平但较低或无法检测到的血清 TSH 与腰椎 BMD 降低独立相关。
